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Z Year3 Resp Conditions > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A

common progressive disorder characterised by airway obstruction with little or no reversibility

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2
Q

What does COPD include?

A
  1. emphysema

2. chronic bronchitis

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3
Q

What is chronic bronchitis defined as clinically?

A

as cough, sputum production on most days for 3 months of 2 successive years

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4
Q

When do symptoms improve in chronic bronchitis?

A

if they stop smoking

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5
Q

What is prognosis for chronic bronchitis?

A

no excess mortality if lung function normal

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6
Q

How is emphysema defined?

A

histologically

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7
Q

How is emphysema diagnosed histologically?

A

enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls but often visualized on CT

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8
Q

What is normal epid for COPD?

A

> 35 and lung function declines with increaseing age

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9
Q

What is the prevalence of COPD?

A
  1. 20-20% of over 40s

2. 2.5x10^6 deaths/yr worldwide

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10
Q

What is the pathophysiology for COPD?

A
  1. Chronic inflammation that affects central and peripheral airways, lung parenchyma and alveoli and pulmonary vasculature
  2. Repeated injury and repair leads to structural and physiological changes
  3. Inflammatory and structural changes in lung increase with disease severity and persist after smoking cessation
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11
Q

What are RF for COPD?

A
  1. Smoking
  2. Pollution
  3. Ocuupational exposure dusts, chemicals
  4. Childhood respiratory disease or infection or malnourishment causing accelerated decline
  5. Lack of anti-inflammatories to prevent inflammation – e.g. a1-antitrypsin deficiency
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12
Q

How is COPD different to asthma?

A
  1. Sputum production
  2. Chronic dyspnoea
  3. Minimal diurnal or day-day FEV1 variation
  4. Smoking/pollution
  5. Over35
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13
Q

What symptoms are in COPD?

A
  1. Cough
  2. Sputum – produced not always coughed up
  3. Dyspnoea persistent unlike asthma + worse with exercise
  4. Wheeze – check as exclude pulmonary oedema
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14
Q

What are the peripheral signs of COPD?

A
  1. tripod
  2. flared nostrils
    3, accessory muscles
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15
Q

What is cor pulmonale?

A

right side heart failure caused by chronic pulmonary arterial hypertension

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16
Q

What are possible DDx for COPD?

A
  1. Asthma
  2. Congestive heart failure
  3. Bronchiectasis
  4. TB
  5. Bronchiestasis
  6. TB
  7. Bronchiolitis
  8. Upper airway dysfunction
  9. Lung cancer
  10. ACE-inhibitor induced chronic cough etc
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17
Q

What spirometry findings are in COPD?

A
  1. FEV1<80% predicted

2. FEV1/FVC<0.7

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18
Q

How to you classify COPD?

A

Standardised symptoms score: GOLD guidelines, use mMRC and CAT assessment tools

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19
Q

What is pulse ox like in COPD?

A

low

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20
Q

What imaging is used in COPD?

A
  1. CXR

2. ECG

21
Q

What does CXR show in COPD?

A
  1. hyperinflation
  2. flat hemidiaphragms
  3. larger central pulmonary arteries
  4. decreased peripheral vascular marking
  5. bullae
22
Q

What would ECG show in COPD?

A
  1. right atrial and ventricular hypertrophy (cor pulmonae)

2. arrythmia and ischemia

23
Q

What would ABG show in COPD?

A
  • Low PaO2

- Hypercapnia

24
Q

What would FBC show in COPD?

A
  1. raised haematocrit
  2. anaemia
  3. possible increased WBC count
25
Q

What are non medicinal measures for COPD?

A
  1. Educate
  2. Reduce RF
  3. Pneumoccocal and influenza vaccines
  4. Personal COPD plan
26
Q

What medications can be used in COPD?

A 
Bronchodilators
Inhaled corticosteroids
Phosphodiesterase-4 inhibitors 
Antibiotics
Mucolytics
27
Q

When is LT oxygen therapy used?

A

improves survival in severe COPD, very severe

28
Q

What is GOLD 1?

A

mild: FEV1 ≥80% predicted

29
Q

What is GOLD 2?

A

moderate: 50% ≤ FEV1 <80% predicted

30
Q

What is GOLD 3?

A

severe: 30% ≤ FEV1 <50% predicted

31
Q

What GOLD 4?

A

very severe: FEV1 <30% predicted

32
Q

What is treatment for COPD If breathless and has exercise limitation (consider CAT if unsure)?

A

SABA or SAMA PRN

33
Q

What is the treatment for COPD if symptoms continue or patient has exacerbations

A

reduce RF + review adherence

34
Q

What asthmatic features can be present in COPD?

A
  • Hx of asthma
  • FEV1 variability
  • High eosinophils
  • Peak flow variability >20%
35
Q

If there are asthmatic features how do you treat COPD?

A

LABA + ICS or LABA + LAMA + ICS

36
Q

If there are not asthmatic features how do you treat COPD?

A

LABA + LAMA then LABA + LAMA + ICS

-If ICS does nothing in 4 weeks then go back to LABA + LAMA

37
Q

What can be added to treatment of COPD?

A
  1. short acting bronchodilator
  2. supportive care and advice
  3. pulmonary rehab
  4. oxygen therapy and/or ventilatory support
  5. mucolytic
  6. theophylline
  7. bronchoscopic intervention or surgery
38
Q

What are possible complications of COPD?

A
  1. Acute exacerbation + infection
  2. Cor pulmonale
  3. Lung cancer
  4. Recurrent pneumonia
  5. Depression
  6. Pneumothorax
  7. Resp failure
  8. Anaemia
  9. Polycytheameia
39
Q

What cell is common in patho of COPD?

A

macrophages

40
Q

What does the uncontrolled inflammation mean?

A
  1. Too many proteases and not enough anti-proteases
  2. Reactive oxygen species
  3. Immune cell recruitment
41
Q

What does the uncontrolled inflammation lead to?

A
  • Leads to small airway obstruction, emphysema, more goblet cells so more mucus
  • eventually IRREVERSIBLE AIRWAY OBSTRUCRTION
42
Q

What are the hypercapnia signs in COPD?

A

Flap, bounding pulse

43
Q

What are other signs in COPD?

A
  1. Tachypoea with prolongued expiration
  2. Barrel chest – loss of percussion dullness over heart and liver
  3. Cor pulmoale: right ventricular heave, JVP elevated and ankle oedema
  4. Hoover’s sign
  5. Decreased cricosternal distance
44
Q

How can you tell COPD on auscultation?

A
  1. Decreased expansion
  2. Resonant or hyperresonant percussion note
  3. Quiet breath sounds
  4. Wheeze
45
Q

What is the gold standard investigation for COPD?

A

spirometry

46
Q

Why would you give LTOT?

A
  • Giving oxygen to wrong people can cause resp depression
  • Consider if patient may need and be eligible for LTOT
  • Refer to specialist
  • 2 ABGs 3 weeks apart in non-smoking, stable patients on optimal pharmacological treatment
47
Q

What would you consider LTOT?

A
  1. PaO2 <7.3 when stable
    Or
  2. PaO2 between 7.3 and 8kPa when stable with >1 of: secondary polycythaemia, peripheral oedema, pulmonary hypertension
48
Q

What are different stages for COPD?

A

Stage I mild: FEV1 >18%
Stage 2 moderate: 50-79
Stage 3 severe: 30-49
IV very severe <30 or <50 with resp failure

49
Q

What is included in a individualised exacerbation plan for COPD?

A
  1. Identify at risk patients
  2. Previous exacerbation in last year
  3. Educate and make sure patient are informed on meds and confident in how and when to use them
  4. Ensure patients are aware to tell HCP when they have had to use rescue packs
  5. Prescribe short course oral antibtiocs and oral corticosteroids to take at home when they have an exacerbation

Z Year3 Resp Conditions (20 decks)

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